Navigation with the StealthStation™ in Skull Base Surgery: An Otolaryngological Perspective

Abstract

The introduction of computer-assisted navigation systems has played a significant role in assuring the integration and consistent intraoperative use of radiological information. We used a frameless stereotactic navigation system to treat 62 patients with a variety of skull base pathologies. The optoelectric appliance uses digital imaging information to locate surgical instruments in the operative area. The aim of this study was to evaluate the clinical accuracy, practicality, and impact of this navigation system on otolaryngological procedures. In conjunction with rigid head fixation and bone-anchored registration markers, the precision of registration was 0.8 mm and the accuracy of clinical measurements was less than 2 mm. With conventional fiducials and flexible head positioning, deviations were as large as 4.5 mm. The additional use of surface registration increased the precision of registration. Preoperative preparations took 15 to 35 minutes, depending on the complexity of the planning. Intraoperative computer support is an important aid to a surgeon's orientation, especially when a patient's anatomy is atypical. Navigation systems will likely improve the quality of surgery and facilitate training.

Navigation-assisted Surgery for Bone and Soft Tissue Tumors With Bony Extension

“…Computer-assisted surgery has been performed for cranial biopsies and tumor resections for two decades [6,12,13,21,24,26,34] before being introduced to the field of orthopaedics [1, 5, 8, 9, 11, 15-17, 19, 23, 29, 30]. Currently, navigation systems often use CT data to navigate pedicle screw applications [1,11,17], cup placements for hip arthroplasties [16], TKAs [8,19], and cruciate ligament reconstructions [9,23].…”

CT Radiation Dose for Computer-Assisted Endoscopic Sinus Surgery: Dose Survey and Determination of Dose-Reduction Limits

“…Alternatively, multiple discrete surface landmarks can be defined by touching the face with a pointer or setting laser light points (surface registration). Screw-based registration has proved to be the most accurate method 4 and was, therefore, chosen for our study to keep influential factors, other than dose-associated image quality, as limited as possible. Correlation between the patient's position and the instruments is maintained during the intervention by an optical, electromechanical, electromagnetic, or sonographic link.…”

“…1 This value indicates the maximal deviation between patient and image data. 4 RMSE was recorded after placing the pointer tip in the screw head pit in line with the main axis of the screw. Screws 1-4 were used as bone-anchored fiducials for registration.…”

“…mage-guided navigation systems are increasingly used for minimally invasive techniques like functional endoscopic surgery of the paranasal sinuses (FESS) 1,2 and other ear, nose, and throat (ENT) surgical procedures [3][4][5] or in neurosurgery. 6 In FESS, only a limited view of the anatomy is warranted, and the use of these systems aims at avoiding injury to important anatomic structures around the orbit and the anterior skull base, especially the internal carotid artery, the optic nerve, and the floor of the anterior skull base.…”

The Assessment of Distortion in Neurosurgical Image Overlay Projection

“…Although the intraoperative accuracy is inferior with adhesive skin fiducial markers, there are a number of disadvantages with the use of osteosynthetic screws, such as long-term cosmetic effects and cost. 11 Mascott also assessed the accuracy of the StealthStation through neuronavigation-guided placement of electrodes for the study of epilepsy. By comparing pre-and postoperative imaging, he reported a mean accuracy of 2.4 ± 1 mm, when corrected for depth, for the placement of 42 electrodes.…”